Schizophrenia

Schizophrenia,
Schizotypal and
Delusional disorders

Outline
• Introduction
• Definition
• Incidence
• etiology
• Prognostic factors
• Clinical features
• Subtypes
• Other forms of psychotic disorders
• Treatment
• Nursing interventions

Introduction
• Schizophrenia is a group of severe mental disorders characterized
by reality distortions resulting in unusual thought patterns and behaviors.
Because there is often little or no logical relationship between the thoughts
and feelings of a person with schizophrenia, the disorder has often been
called “split personality.”
• Schizophrenia is considered the most common and disabling of the
psychotic disorders. Although it is a psychiatric disorder, it stems from a
physiologic malfunctioning of the brain. This disorder affects all races, and
is more prevalent in men than in women. No cultural group is immune and
persons with intelligence quotients of the genius level are not spared.

Introduction
• Schizophrenia occurs twice as often in people who are unmarried and
divorced people as in those who are married or widowed. People with
schizophrenia are more likely to be members of lower socioeconomic
groups.
• In 1896 Emil Kraepelin originally called schizophrenia as dementia
praecox meaning “madness of the young” to differentiate it from
manic-depressive psychosis due to the presence of hallucinations
and delusions

Introduction
• The term schizophrenia was coined by a German psychiatrist, Eugen
Bleuler, in 1908
• He defined the disorder through the presence of two groups of
symptoms: Primary symptoms – with 4As ,they are
• flattened Affect,
• Autism,
• impaired Association of ideas and
• Ambivalence,
Secondary symptoms – include delusions, hallucinations, and
disorganized, idiosyncratic speech.

Introduction
• Affective disturbance refers to the person’s inability to show
appropriate emotional responses.
• Autistic thinking is a thought process in which the individual is
unable to relate to others or to the environment.
• Ambivalence refers to contradictory or opposing emotions, attitudes,
ideas, or desires for the same person, thing, or situation.
• Looseness of association is the inability to think logically. Ideas
expressed have little, if any, connection and shift from one subject to
another

Definition
• Schizophrenia is a disorder characterized by disturbances, for at least
6 months, in the thought content and form, perception, affect, sense
of self, volition, interpersonal relationships, and psychomotor
behavior.
• Schizophrenia is a psychotic condition characterized by disturbance
in thinking, emotions, volitions(desires) and faculties in the presence
of clear consciousness which usually leads to social withdrawal.

Incidence
• Onset of symptoms typically occurs in late adolescence or young
adulthood.
 Schizophrenia occurs equally in males and females, although
typically appears earlier in men—the peak ages of onset are 20–28
years for males and 26–32 years for females.
Around 1% of the population is affected. Diagnosis is based on the
patient's self-reported experiences and observed behavior.
No laboratory test for schizophrenia currently exists (APA, 2000)

Incidence
The average life expectancy of people with the disorder is 10 to 12 years less than
those without, due to increased physical health problems and a higher suicide rate
(about 5%).
 Social stigma has been identified as a major obstacle in the recovery of patients
with schizophrenia with a large number of people believing that individuals with
schizophrenia were “very likely” to be violent against others.
Common in urban areas with those who are unemployed, poor, and homeless.
Schizophrenics form about half of the patients occupying mental hospital beds.
The prognosis worsens with each acute episode.

Etiology
• 1. Biological factors
a. Biochemical (neurochemical) changes:
• Increased dopamine activity in the mesolimbic pathway of
the brain is consistently found in schizophrenic individuals.
• The dopamine hypothesis posits that an excessive amount
of the neurotransmitter dopamine allows nerve impulses to
bombard the mesolimbic pathway, the part of the brain
normally involved in arousal and motivation. Normal cell
communication is disrupted, resulting in the development of
hallucinations and delusions. Norepinephrine and serotonin
systems have also been implicated in the causation of
schizophrenia.

b. Endocrine factors:
• Changes in prolactin, melatonin, and thyroid function have been found in schizophrenia.
c. Brain structural changes:
• Prefrontal cortex and limbic cortex are less developed in patients with Schizophrenia.
• MRI studies show-
• Decreased brain volume
• Larger lateral and third ventricles
• Atrophy in frontal lobe, cerebellum
• Increased size of sulci on the surface of the brain

d. Prenatal:
• Causal factors are thought to initially come together in early neurodevelopment
to increase the risk of later developing schizophrenia. One finding is that
people diagnosed with schizophrenia are more likely to have been born in
winter or spring, (at least in the northern hemisphere).
• There is evidence that prenatal exposure to infections (i.e., prenatal exposure
to influenza during the second trimester) increases the risk for developing
schizophrenia later in life, providing additional evidence for a link between in
utero developmental pathology and risk of developing the condition. Other
gestational and birth complications, such as Rh factor incompatibility, as well
as prenatal nutritional deficiencies, have been associated with schizophrenia.

e. Vitamin deficiency:
• The vitamin deficiency theory suggests that persons, who are deficient in vitamin
B, namely B1, B6, and B12, as well as in vitamin C, may become schizophrenic as
a result of a severe vitamin deficiency.
f. Genetics: It has been noted that the closer the biological relationship between an
individual and a person considered to be schizophrenic, the greater the disorder. This
is based on data from family studies.
Family studies: A child born with one schizophrenic parent has about a 50%
chance of developing schizophrenia. It is 100% if both parents are schizophrenics.
There is 50% chance of developing the condition when a sibling is schizophrenic,
i.e., non-twin siblings. Second degree relatives have 25% chances of suffering the
illness; when no relative is affected with the illness, the chances are 2–3% of a
family member developing the condition.

Twin and Adoption studies:
According to these studies if one of the monozygotic (identical) twins suffers schizophrenia,
there is 100% chance of the other twin also developing the condition. For the dizygotic (non-
identical) twins, there is 50% chance of the other catching the condition.

• 2. Psychological Factors
• a. Personality traits: Personality characteristics of an individual, such as
withdrawn, extreme quietness and shyness, highly dependent and obedient,
having temper tantrums, and always looking sad and miserable, may become
schizophrenic
• b. Cognitive biases: that have been identified in those with a diagnosis or those
at risk, especially when under stress or in confusing situations include:
• excessive attention to potential threats,
• jumping to conclusions,
• impaired reasoning about social situations and mental states,
• difficulty distinguishing inner speech from speech from an external source, and
• difficulties with early visual processing and maintaining concentration.

3. Environmental/Social Factors
• a. Recreational drug use: Although about half of all patients
with schizophrenia use drugs or alcohol, a clear causal
connection between drug use and schizophrenia has been
difficult to prove. The two most often used explanations for this
are “substance use causes schizophrenia” and “substance use
is a consequence of schizophrenia”, and they both may be
correct

• b. Childhood experiences of abuse or trauma have also been implicated as risk
factors for a diagnosis of schizophrenia later in life. Parenting is not held
responsible for schizophrenia but unsupportive dysfunctional relationships may
contribute to an increased risk.
• c. Social: Living in an urban environment has been consistently found to be a risk
factor for schizophrenia. Social disadvantage found to be a risk factor, include:
▫ poverty,
▫ migration related to social adversity,
▫ racial discrimination,
▫ family dysfunction,
▫ unemployment
▫ poor housing conditions.

• Developmental factors – complication of the foetus during
pregnancy may result in the condition, e.g., malnutrition,
maternal drug use/alcoholism, asphyxia, infections, forceps
delivery, etc.
• Double bind theory – Schizophrenia is a consequence of
abnormal patterns in family communication or a person is given
mutually contradictory signals by another person.

DOUBLE BIND AS A THEORY
• Bateson et al. (1956) proposed that schizophrenic symptoms are an expression of social
interactions in which the individual is repeatedly exposed to conflicting injunctions, without
having the opportunity to adequately respond to those injunctions, or to ignore them (i.e.,
to escape the field).
• For example, if a mother tells her son that she loves him, while at the same time turning
her head away in disgust, the child receives two conflicting messages about their
relationship on different communicative levels, one of affection on the verbal level, and one
of animosity on the nonverbal level.
• It is argued that the child's ability to respond to the mother is incapacitated by such
contradictions across communicative levels, because one message invalidates the other.
Because of the child's vital dependence on the mother, Bateson et al. argue that the child
is also not able to comment on the fact that a contradiction has occurred, i.e., the child is
unable to metacommunicate .

Prognostic factors
• Prognosis indicates the likelihood of recovery from a disease. Factors
which are responsible for a good prognostic outcome of
schizophrenia are:
• Age of the patient – The older the patient, the more favorable the
prognosis.
• The duration of illness – The shorter the duration prior to treatment, the
better the outcome.
• The rapidity of development of the symptoms – Surprisingly, it has been
found that the more speedily the symptoms develop, the faster do they
respond to treatment; a very slow, insidious, and gradual onset of illness
suggests a final poor outcome.

• A patient who had close friendships and multiple relationships prior to illness
has a brighter chance with few or no such relationships.
• Life stress prior to onset – An episode brought on by a major identifiable life
stress will respond more quickly than an episode without any obvious cause.
• Marital history – A patient with a stable and helpful marital partner has a
favorable prognosis as compared to an unmarried patient.
• Educational history – The higher the level of education, the more are the
chance of a patient coming rapidly to terms with the illness and handling the
post-illness sequence.

• Occupational history – A patient with a good stable occupation or business prior to
onset of illness will respond better than a patient who is jobless and economically
unsound.
• Family’s attitude towards the returning patient – Hostile behavior by family
members, or vice versa, excessive care and attention by them can undermine the
patient’s sense of confidence and hamper recovery.
• Social support systems – A patient with a joint family and a staunch circle of
friends who are ready lend a helping hand, is much better off than alone man
afflicted with the illness, whose relatives are in some far off land, and who has no
one to turn to.
• Organic brain damage – Presence of concurrent obvious brain damage (mental
retardation, epilepsy, head injury, etc.) hinders the final adequate recovery from
schizophrenia.

• Factors which may indicate a poor or bad prognosis include:
▫ - Earlier age of onset
▫ - Being a male
▫ - A higher number of negative symptoms
▫ - A family history of schizophrenia
▫ - A low level of functioning prior to onset
▫ - Poor or no support system
▫ - A history of substance abuse

Risk factors
• Certain factors seem to increase the risk of developing or
triggering schizophrenia, including:
▫ Having a family history of schizophrenia
▫ Exposure to viruses, toxins or malnutrition while in the womb,
particularly in the first and second trimesters
▫ Stressful life circumstances
▫ Older paternal age
▫ Taking psychoactive drugs during adolescence and young
adulthood

Clinical features
• Positive/Active Symptoms:
• The term positive symptom refers to symptoms that most
individuals do not normally experience but are present in
schizophrenia. They include
• delusions,
• hallucinations (auditory),
• thought disorder, and
• disorganized behavior.

• Negative/Deficit symptoms:
• Symptoms that reflect the loss or absence of normal traits or
abilities. Common negative symptoms include
• flat or blunted affect and emotion,
• poverty of speech (alogia),
• inability to experience pleasure (anhedonia),
• lack of desire to form relationships (asociality),
• isolation (social withdrawal) and
• lack of motivation (avolition).

• Negative symptoms contribute more to poor quality of life, functional
disability, and the burden on others than do positive symptoms.
• A third symptom grouping, the disorganization syndrome, is sometimes
described, and includes chaotic speech, thought, and behavior.
• Cognitive symptoms involve problems with thought processes. These
symptoms may be the most disabling in schizophrenia because they
interfere with the ability to perform routine daily tasks. A person with
schizophrenia may be born with these symptoms. They include:
• Problems with making sense of information
• Difficulty paying attention
• Memory problems

Impact of schizophrenia
• Because of disordered thought processes, the schizophrenic patient
often neglects personal hygiene or ignores health needs. As a result,
the patient has a shorter life expectancy than the general population.
Ten percent of schizophrenic patients commit suicide.
• Other complications include:
▫ Aggression
▫ Violence
▫ Violence against others
▫ Increased risk of substance abuse (exacerbating symptoms in some
patients)

Clinical types of schizophrenia

Types of schizophrenia
Paranoid type: ( F20.0)
• Paranoid delusions and hallucinations (auditory) are present
• but thought disorder, disorganized behavior, and affective flattening
are absent.
• The individual is often tense, suspicious, and guarded,
• may be argumentative, hostile, angry and aggressive.
• At the workplace, he has the false notion that co-workers talk about
him behind his back and laugh quietly as he passes

Paranoid – cont’d
• Patient may refuse to eat meals served of the suspicion that
the food is secretly poisoned. He may appeal to authorities for
help.
• Grandiose delusions may also dominate the clinical picture.
For example, he believes himself anointed with holy oil, trumpets
blared forth his appearance as a prophet. He has a message
that will save the world, and sets about spreading it.

Disorganized type: Hebephrenic schizophrenia in the ICD.(F20.1)
• Affective changes are prominent,
• delusions and hallucinations fleeting and fragmentary,
• behavior irresponsible and unpredictable, and mannerisms
common.
• The mood is shallow and inappropriate,
• Thought is disorganized, and speech is incoherent.
• There is a tendency to social isolation.
• Usually the prognosis is poor because of the rapid development
of "negative" symptoms, particularly flattening of affect and loss
of volition.
• Hebephrenia should normally be diagnosed only in adolescents
or young adults.

Catatonic type: (F20.2)
• Catatonic schizophrenia is dominated by prominent psychomotor
disturbances that may alternate between extremes such as hyperkinesis
and stupor, or automatic obedience and negativism.
• Constrained attitudes and postures may be maintained for long periods.
Episodes of violent excitement may be a striking feature of the condition.
• The catatonic phenomena may be combined with a dream-like (oneiroid)
state with vivid scenic hallucinations.

• Catatonic type Symptoms can include:
• 1. catatonic stupor: This is extreme immobility without
evidence of absent or decreased consciousness. The patient is
also rigid and mute and only appears to be conscious as the
eyes are open and follow surrounding objects.
• Example: The patient sits immobile in a chair for sixteen hours,
staring fixedly, apparently unaware of other people or his own
bodily needs.

• 2. waxy flexibility: The patient remains in any position that s/he
is placed. The patient is nearly or completely unresponsive to
stimuli and remains immobile for long periods of time.
• Example: A schizophrenic man stands stock-still near his bed.
When a psychiatrist lifts the man’s arm, it remains in the exact
same position for hours after she lets go

• 3. catatonic excitement: this involves purposeless motor activity and
agitation. The patient shows impulsivity, destructive behaviour which
urgently require physical and medical control because s/he is often
destructive and violent to others, and his/her excitement can cause him/her
to injure him/herself or to collapse from complete exhaustion. Pernicious or
acute lethal catatonia is the other name used to describe excited catatonia.
• Example: The patient runs aimlessly through the dining hall due to an
episode of catatonic excitement, knocking over objects without apparent
regard, and ignoring all outside attempts to stop or redirect her.

Undifferentiated Schizophrenia( F20.3)
• Psychotic conditions meeting the general diagnostic criteria for schizophrenia but
not conforming to any of the subtypes in F20.0-F20.2(paranoid, catatonic,
disorganized or residual), or exhibiting the features of more than one of them
without a clear predominance of a particular set of diagnostic characteristics.
Symptoms :The person with this type of schizophrenia must have at least two or more
of the following symptoms:
▫ Delusions
▫ Hallucination
▫ Disorganized speech
▫ Extremely disorganized or catatonic behavior
▫ Negative symptoms

Post-schizophrenic depression(F20.4)
• A depressive episode, which may be prolonged, arising in the
aftermath of a schizophrenic illness. Some schizophrenic
symptoms, either "positive" or "negative", must still be present
but they no longer dominate the clinical picture.
• These depressive states are associated with an increased risk of
suicide.
• If the patient no longer has any schizophrenic symptoms, a
depressive episode should be diagnosed (F32.-). If
schizophrenic symptoms are still florid and prominent, the
diagnosis should remain that of the appropriate schizophrenic
subtype

Residual Schizophrenia: (F20.5)
• Positive symptoms are present at a low intensity only.
• This diagnostic category is used when the individual has a history of
at least one previous episode of schizophrenia.
• At this stage, there is continuing evidence of the illness, although
there are no prominent psychotic symptoms.
• symptoms may include social isolation, eccentric (strange/unusual)
behaviour, impairment in personal hygiene and grooming, blunted or
inappropriate affect, poverty of or overly elaborate speech, illogical
thinking or apathy. For most part, however, the patient does little to
attract any attention.

Simple schizophrenia (F20.6)
• A disorder in which there is an insidious but progressive development of
oddities of conduct, inability to meet the demands of society, and decline in
total performance.
• The characteristic negative features of residual schizophrenia (e.g. blunting
of affect and loss of volition) develop without being preceded by any overt
psychotic symptoms. i.e., hallucinations and delusions may be absent.
 Very poor prognosis

Other schizophrenia (F20.8)
• Cenesthopathic schizophrenia
Schizophrenia, unspecified (F20.9)

Schizotypal disorder (F21)
• A disorder characterized by eccentric behaviour and abnormalities of thinking
and affect which resemble those seen in schizophrenia, though no definite and
characteristic schizophrenic abnormalities occur at any stage.
• The symptoms may include a cold or inappropriate affect; anhedonia; odd or
eccentric behaviour; a tendency to social withdrawal; paranoid or bizarre ideas
not amounting to true delusions; obsessive ruminations; thought disorder and
perceptual disturbances; occasional transient quasi-psychotic episodes with
intense illusions, auditory or other hallucinations, and delusion-like ideas,
usually occurring without external provocation. There is no definite onset and
evolution and course are usually those of a personality disorder.

Persistent delusional disorders(F22)
• Includes a variety of disorders in which long-standing
delusions constitute the only, or the most conspicuous, clinical
characteristic and which cannot be classified as organic,
schizophrenic or affective.
• Delusional disorders that have lasted for less than a few
months should be classified, at least temporarily, under F23.-.

Acute and transient psychotic disorders (F23):
• A group of disorders characterized by the acute onset of psychotic symptoms such as
delusions, hallucinations, and perceptual disturbances, and by the severe disruption of
ordinary behaviour.
• Acute onset -development of a clearly abnormal clinical picture in about two weeks or
less. For these disorders there is no evidence of organic causation.
• Confusion are often present but disorientation for time, place and person is not
persistent
• Complete recovery usually occurs within a few months, often within a few weeks or even
days. If the disorder persists, a change in classification will be necessary. The disorder
may or may not be associated with acute stress, defined as usually stressful events
preceding the onset by one to two weeks.

Induced delusional disorder (F24):
• A delusional disorder shared by two or more people with close
emotional links. Only one of the people suffers from a genuine
psychotic disorder; the delusions are induced in the other(s)
and usually disappear when the people are separated.

Schizoaffective disorders (F25) :
• Episodic disorders in which both affective and schizophrenic
symptoms are prominent but which do not justify a diagnosis
of either schizophrenia or depressive or manic episodes.

Schizoaffective disorder, manic type (F25.0)
• A disorder in which both schizophrenic and manic symptoms are
prominent so that the episode of illness does not justify a diagnosis
of either schizophrenia or a manic episode. This category should be
used for both a single episode and a recurrent disorder in which the
majority of episodes are schizoaffective, manic type.
Schizoaffective disorder, depressive type (F25.1):
• A disorder in which both schizophrenic and depressive symptoms
are prominent so that the episode of illness does not justify a
diagnosis of either schizophrenia or a depressive episode. This
category should be used for both a single episode and a recurrent
disorder in which the majority of episodes are schizoaffective,
depressive type.

Schizoaffective disorder, mixed type ( F25.2)
Cyclic schizophrenia
Mixed schizophrenic and affective psychosis

Diagnostic evaluation
• Mental status examination
• Psychiatric history
• Careful clinical observation
• CT scan and MRI show enlarged ventricles, sulci on cerebral
surface and atrophy of the cerebellum

Normal brain Enlarged
ventricles

Treatment modalities
1. Pharmacotherapy
• Antipsychotics
Conventional/typical AP
Chlorpromazine :300-1500 mg/day PO, 50-100
mg/day IM
Fluphenazine deconoate: 25-50 mg IM every 1-3
weeks
Haloperidol: 5-100 mg /day PO, 2-20 mg/ day IM
Trifluoperazine: 15-60 mg/day PO, 1-5 mg/day
IM

Atypical AP
Other drugs: Anti depressants, mood stabilizers,
benzodiazepines,etc..
• Clozapine:25-450 mg/day PO
• Resperidone:2- 10 mg/day PO
• Olanzapine: 10-20 mg/day PO
• Quetiapine: 150-750 mg/day PO
• Ziprasidone: 20-80 mg/day Po

Non pharmacological Treatment of
Schizophrenia
• ECT (8-12 ECTs are needed)
• Psychosocial Rehabilitation to improve activities of daily living
• Individual Psychotherapy
• Group Psychotherapy
• Social Skills Training
• Cognitive Behavior therapy
• Family Therapy
• Education & support, for both ill individuals and families
• Vocational and recreational support

Nursing Interventions For Schizophrenia
• Assess the patient’s ability to carry out the activities of daily living, paying
special attention to his nutritional status. Monitor his weight if he is not
eating. If he thinks that his food is poisoned, allow him to fix his own food
when possible, or offer him foods in closed containers that he can open. If
you give liquid medication in a unit-dose container, allow the patient to
open the container.
• Maintain a safe environment, minimizing stimuli. Administer medication to
decrease symptoms and anxiety. Use physical restraints according to the
hospital’s policy to ensure the patient’s safety and that of others.

Nursing Interventions For Schizophrenia
• Adopt an accepting and consistent approach with the patient. Do not avoid
or overwhelm him. Keep in mind that short, repeated contacts are best until
trust has been established.
• Avoid promoting dependence. Meet the patient’s needs, but only do for the
patient what he cannot do for himself.
• Reward positive behavior to help the patient improve his level of
functioning.

• Engage the patient in reality-oriented activities that involve human contact:
inpatient social skills training groups, outpatient day care, and sheltered
workshops. Provide reality-based explanations for distorted body images or
hypochondriacal complaints.
• Clarify private language, autistic inventions, or neologisms, explaining to
the patient that what he says is not understood by others. If necessary, set
limits on inappropriate behavior.

 If the patient is hallucinating, explore the content of the hallucinations. If
he has auditory hallucinations, determine if they are command
hallucinations that place the patient or others at risk.
 Tell the patient you do not hear the voices but you know they are real to
him. Avoid arguing about the hallucinations; if possible, change the subject.
 Do not tease or joke with the patient. Choose words and phrases that are
unambiguous and clearly understood. For instance, a patient who’s told,
“That procedure will be done on the floor”, may become frightened, thinking
he is being told to lie down on the floor.

• Do not touch the patient without telling him first exactly what you are
going to do. For example, clearly explain to him, I’m going to put this
cuff on your arm so I can take your blood pressure. If necessary,
postpone procedures that require physical contact with hospital
personnel until the patient is less suspicious or agitated.
• Remember, institutionalization may produce new symptoms and
handicaps in the patient that are not part of his diagnosed illness, so
evaluate symptoms carefully.

• Mobilize community resources to provide a support system for the
patient and reduce his vulnerability to stress. Ongoing support is
essential to his mastery of social skills.
• Encourage compliance with the medication regimen to prevent
relapse. Also monitor the patient carefully for adverse effects of drug
therapy, including drug-induced parkinsonism, acute dystonia,
akathisia, tardive dyskinesia, and malignant neuroleptic syndrome.
Make sure you document and report such effects promptly.

Nursing interventions for agitation, hallucinations, and
delusions
Agitation
• Remove client from, or avoid, situations known to cause agitation.
• Decrease stimulants such as caffeine, bright lights, and loud noise or
music.
• Avoid display of anger, discouragement, or frustration when interacting with
client.
• Avoid criticism and do not argue with client.
• Set limits and follow through with consequences if a violation occurs.
• Monitor for physical discomfort such as pain or physical illness.
• Administer prescribed medication as ordered.

delusions
• Hallucinations
• Decrease environmental stimuli such as loud music, extremely bright
colors, or flashing lights.
• Attempt to identify precipitating factors by asking the client what happened
prior to the onset of hallucinations.
• Monitor television programs to minimize external stimuli that may
precipitate hallucinations.
• Monitor for command hallucinations that may precipitate aggressive or
violent behavior.
• Administer prescribed medication as ordered.

delusions
Delusions
• Do not whisper or laugh in the presence of the client.
• Do not argue with the client or attempt to disprove delusional or suspicious
thoughts.
• Explain all procedures and interventions, including medication
management.
• Provide for personal space and do not touch the client without warning.
• Maintain eye contact during interactions with client.
• Provide consistency in care and assigned caregivers to establish trust.

Clients who are suspicious and rude
• Form professional relationships; can be considered a threat if too friendly.
• Be careful with the touch as it can be regarded as a threat.
• Give as much control and autonomy to client within the therapeutic limits.
• Create a sense of trust through brief interactions that communicate caring and respect.
• Describe any treatment, medication and laboratory tests before the start.
• Do not focus or strengthen the suspicion or delusional ideas.
• Identify and respond to the emotional needs of the underlying suspicion or delusional
thoughts
• Intervene when the client shows signs of increasing anxiety and potentially express an
unconscious behavior.
• Be careful not to behave in a way that could be misinterpreted by the client.

THE NURSE’S ROLE DURING MEDICATION MANAGEMENT:
• Administering medication,
• Monitoring responses to the prescribed medication, and
• reporting any adverse effects.
• The nurse also plays a major role in developing a therapeutic
relationship and educating the client and family about prescribed
medication to promote compliance.

• PREVENTION OF SCHIZOPHRENIA
• Seek early treatment (to control symptoms before complications develop
and to improve long-term outlook)
• Stick to treatment plan (to prevent relapses or worsening of
schizophrenia symptoms)
• Learn about risk factors may lead to earlier diagnosis and earlier
treatment
• Avoid illegal drug and alcohol use
• Reducing stress

• Getting enough sleep
• Avoid social isolation
• Plan your pregnancy (have a child when you want one, and don’t
have a child if you don’t want one)
• Eat a healthy diet with a lot of vegetables, fish with omega 3 fatty
acids.
• Avoid head injuries
• Vitamin D supplements

Conclusion
Drug and psychosocial interventions for the symptoms of
schizophrenic disorders contribute to a lower incidence and
prevalence of schizophrenia. Nurses will be able to offer better
care through the use of nursing models and theories in the care of
Schizophrenics.

Schizophrenia

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